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Cases from the Community: Clinical Investigators Provide Their Perspectives on Actual Breast Cancer Cases and the Implications of Emerging Research
Released March 2018

Proceedings from a satellite symposium during the 40th annual San Antonio Breast Cancer Symposium. Featuring perspectives from Drs Kimberly L Blackwell, Kathy D Miller, Joyce O'Shaughnessy, George W Sledge Jr and Sara M Tolaney. (Video Program)

CE Disclosures and Faculty Information

    This activity is intended for medical oncologists, breast surgeons, radiation oncologists and other healthcare professionals involved in the diagnosis and treatment of breast cancer.

    The current clinical management of breast cancer is multidisciplinary and includes surgical resection of local disease with or without radiation therapy and the treatment of systemic disease with cytotoxic chemotherapy, endocrine therapy, biologic therapy or combinations of these approaches. The indication and/or utility of these local and systemic treatment options is largely based on a number of prognostic and predictive risk factors present within the patient or her tumor at the time of diagnosis. Increasingly, an emphasis is being placed on a “personalized medicine” approach that promises to more effectively identify specific treatments that will benefit individuals based on specific patient- and disease-related characteristics. In conjunction with this approach, researchers are developing novel agents and immunotherapeutic strategies with the aim of enhancing the efficacy of existing treatments or overcoming resistance to endocrine therapy, chemotherapy or biologic agents. The pace of change in the field of breast medical oncology has been rapid, creating an important need for education about the unique mechanisms of action, toxicities and effectiveness of novel agents to properly prepare clinicians for their appropriate use in clinical practice. Several consensus- and evidence-based treatment guidelines are available and aim to assist clinicians with making breast cancer management decisions in the face of this dynamic clinical and research environment, but despite the existence of these tools many areas of controversy persist within academic and community settings.

    These proceedings from a CME symposium during the San Antonio Breast Cancer Symposium explore the most significant therapeutic advances during the previous year by using the perspectives of leading breast cancer experts on challenging cases and questions submitted by clinicians in the community to frame a relevant discussion of how this information has aided in the refinement of current routine clinical practice and ongoing research. This CME activity will help medical oncologists find answers to the individualized questions and concerns that they frequently encounter and in turn provide high-quality cancer care.


    • Consider published data to guide the use of biomarkers and genomic classifiers to assess risk and customize therapy for patients with hormone receptor-positive breast cancer in the neoadjuvant, adjuvant and extended-adjuvant settings.
    • Appraise available and emerging research evidence to individualize the selection and duration of neoadjuvant and adjuvant chemobiologic regimens for patients with HER2-overexpressing early breast cancer.
    • Implement a long-term clinical plan for the management of metastatic HER2-positive breast cancer, incorporating existing and investigational targeted treatments.
    • Develop an evidence-based algorithm for the treatment of advanced hormone receptor-positive pre- and postmenopausal breast cancer, including the use of endocrine, biologic and chemotherapeutic agents.
    • Consider published research findings and patient preferences in the selection and sequencing of available and investigational therapeutic agents for patients with metastatic ER/PR-negative, HER2-negative breast cancer.
    • Develop an understanding of the mechanisms of action of, available data with and potential clinical roles of novel targeted and immunotherapeutic approaches in preparation for their potential introduction into future breast cancer clinical practice.
    • Identify ongoing trials of investigational approaches in breast cancer, and obtain consent and refer patients for study participation.

    Research To Practice is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

    Research To Practice designates this enduring material for a maximum of 2.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 2.5 Medical Knowledge MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

    Please note, this program has been specifically designed for the following ABIM specialty: medical oncology.

    Personal information and data sharing: Research To Practice aggregates deidentified user data for program-use analysis, program development, activity planning and site improvement. We may provide aggregate and deidentified data to third parties, including commercial supporters. We do not share or sell personally identifiable information to any unaffiliated third parties or commercial supporters. Please see our privacy policy at ResearchToPractice.com/Privacy-Policy for more information.

    This CME activity consists of a video component. To receive credit, the participant should review the CME information, watch the video, complete the Post-test with a score of 80% or better and fill out the Educational Assessment and Credit Form located at ResearchToPractice.com/SanAntonioBC17/CME.

    Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess conflicts of interest with faculty, planners and managers of CME activities. Conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent physician reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

    FACULTY — The following faculty (and their spouses/partners) reported relevant conflicts of interest, which have been resolved through a conflict of interest resolution process:

    Kimberly L Blackwell, MD
    Professor of Medicine
    Director, Breast Cancer Program
    Duke Cancer Institute
    Durham, North Carolina

    Advisory Committee: Advaxis Inc, Bayer HealthCare Pharmaceuticals, Eisai Inc, MacroGenics Inc, Merck, Novartis, Pfizer Inc, Pierian Biosciences, Syndax Pharmaceuticals Inc; Consulting Agreements: Celgene Corporation, Coherus BioSciences, G1 Therapeutics, Genentech BioOncology, Lilly, Novartis, Pfizer Inc, Puma Biotechnology Inc, Roche Laboratories Inc, Sandoz; Contracted Research: Celgene Corporation, Genentech BioOncology, Novartis, Pfizer Inc.

    Kathy D Miller, MD
    Co-Director, IU Simon Cancer Center Breast Cancer Program
    Ballvé-Lantero Scholar in Oncology
    Professor of Medicine, Division of Hematology/Oncology
    Indiana University Melvin and Bren Simon Cancer Center
    Indianapolis, Indiana

    Contracted Research: AbbVie Inc, Astellas Pharma Global Development Inc, Medivation Inc, a Pfizer Company, Merrimack Pharmaceuticals Inc, Novartis, Pfizer Inc.

    Joyce O’Shaughnessy, MD
    Chair, Breast Cancer Research Program
    Baylor Charles A Sammons Cancer Center
    Celebrating Women Chair in Breast Cancer Research
    Texas Oncology
    US Oncology
    Dallas, Texas

    Advisory Committee and Consulting Agreements: Amgen Inc, AstraZeneca Pharmaceuticals LP, Celgene Corporation, Eisai Inc, Genentech BioOncology, Lilly, Merck, Novartis, Pfizer Inc, Roche Laboratories Inc, Sanofi Genzyme, Takeda Oncology; Contracted Research: Merck.

    George W Sledge Jr, MD
    Professor of Medicine
    Chief, Division of Oncology
    Department of Medicine
    Stanford University School of Medicine
    Stanford, California

    Advisory Committee: Syndax Pharmaceuticals Inc, Taiho Oncology Inc; Contracted Research: Genentech BioOncology.

    Sara M Tolaney, MD, MPH
    Dana-Farber Cancer Institute
    Associate Director of Clinical Research
    Susan F Smith Center for Women’s Cancers
    Senior Physician
    Assistant Professor in Medicine
    Harvard Medical School
    Boston, Massachusetts

    Advisory Committee: AstraZeneca Pharmaceuticals LP, Merck, NanoString Technologies, Nektar, Puma Biotechnology Inc; Consulting Agreements: AstraZeneca Pharmaceuticals LP, Merck, NanoString Technologies, Nektar, Puma Biotechnology Inc; Contracted Research: AstraZeneca Pharmaceuticals LP, Exelixis Inc, Genentech BioOncology, Lilly, Merck, Nektar, Novartis, Pfizer Inc.

    MODERATOR — Dr Love is president and CEO of Research To Practice, which receives funds in the form of educational grants to develop CME activities from the following commercial interests: AbbVie Inc, Acerta Pharma, Adaptive Biotechnologies, Agendia Inc, Agios Pharmaceuticals Inc, Amgen Inc, Ariad Pharmaceuticals Inc, Array BioPharma Inc, Astellas Pharma Global Development Inc, AstraZeneca Pharmaceuticals LP, Baxalta Inc, Bayer HealthCare Pharmaceuticals, Biodesix Inc, bioTheranostics Inc, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, CTI BioPharma Corp, Dendreon Pharmaceuticals Inc, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Halozyme Inc, ImmunoGen Inc, Incyte Corporation, Infinity Pharmaceuticals Inc, Ipsen Biopharmaceuticals Inc, Janssen Biotech Inc, administered by Janssen Scientific Affairs LLC, Jazz Pharmaceuticals Inc, Kite Pharma Inc, Lexicon Pharmaceuticals Inc, Lilly, Medivation Inc, a Pfizer Company, Merck, Merrimack Pharmaceuticals Inc, Myriad Genetic Laboratories Inc, NanoString Technologies, Natera Inc, Novartis, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pfizer Inc, Pharmacyclics LLC, an AbbVie Company, Prometheus Laboratories Inc, Puma Biotechnology Inc, Regeneron Pharmaceuticals Inc, Sanofi Genzyme, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Tesaro Inc, Teva Oncology and Tokai Pharmaceuticals Inc.

    RESEARCH TO PRACTICE STAFF AND EXTERNAL REVIEWERS — The scientific staff and reviewers for Research To Practice have no relevant conflicts of interest to disclose.

    This educational activity contains discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantors.

    This activity is supported by educational grants from Agendia Inc, AstraZeneca Pharmaceuticals LP, Genentech BioOncology, Genomic Health Inc, Lilly, Novartis and Puma Biotechnology Inc.

    Hardware/Software Requirements:
    A high-speed Internet connection
    A monitor set to 1280 x 1024 pixels or more
    Internet Explorer 11 or later, Firefox 56 or later, Chrome 61 or later, Safari 11 or later, Opera 48 or later
    Adobe Flash Player 27 plug-in or later
    Adobe Acrobat Reader
    (Optional) Sound card and speakers for audio

    Last review date: March 2018
    Expiration date: March 2019

    After completing the Post-test, learners may download and review the answers here in order to identify further areas of study.

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Protocol and Off-Protocol Decision-Making for Patients with HER2-Positive mBC

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